Care By Us Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Outstanding. At this assessment the rating has changed to Requires Improvement. This meant some aspects of the service were not always safe and there was reduced assurance about safety. There was an increased risk that people could be harmed.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People gave mixed feedback regarding their safety. Whilst most people told us they felt the care they received was safe, others expressed concern that some staff were not familiar with them or their needs and this made them feel uneasy. One person told us, “I do feel that I am safe with my carers. I haven’t had to raise any concerns about my safety.” A relative told us, “I do feel that having so many different carers is not a good thing, but I now stay in every morning to see who turns up and also go back about an hour after they have left at lunchtime to check all is well.”

People told us they felt able to raise concerns regarding safety but were not always clear on the actions taken in response.

We received mixed feedback from staff. Whilst some staff told us they felt that incidents and untoward events were learnt from, others felt that they received no feedback or any outcomes once they had made reports. One member of staff told us, “We complete ‘feedback and follow up’ forms as expected but we don’t hear back.”

Team meetings and briefings varied between each area of the service, however evidence provided did not demonstrate that safety concerns or lessons learnt were a routine topic of conversation or within the information shared with staff teams.

The provider had a system in place to record, monitor and plan action following any incidents, accidents or untoward events, however this was not being used consistently or effectively by all areas of the service. Evidence provided did not demonstrate a learning culture.

Each area of the service maintained a log of ‘events’ that had occurred. This included a range of events such as incidents, safeguarding concerns and complaints. Evidence provided did not show detail of any analysis. We also found that the ‘lessons learnt’ recorded within the log were actions taken in response to each event.

We raised this with the provider who confirmed that coaching sessions had been arranged for managers to ensure that records were accurate, and that lessons learnt would be drawn from an analysis completed.

People told us they received an assessment before starting to receive care which they, and their relatives where applicable, were involved in. One person told us, “My care plan was arranged by me and my social worker when I was in [another setting].” A relative told us, “My [sibling] and me were both involved in [their] assessment, and we have had to revise it since [they] moved into [their] present home. We agreed with [their] social worker and [Name of manager] about what [they] needed.”

Staff told us that they were aware that assessments were carried out, but they were not involved in the process. Staff shared with us that they were not always provided with the opportunity to get to know people before delivering care and they felt that this would benefit them in their work.

Managers told us that people were involved in their assessments as much as they were able to and wanted to be.

Feedback from partners was limited, however, we saw there were systems in place for information sharing between services and an exchange of assessment documentation when packages of care and support were being arranged.

The provider had an admissions process and managers, and partner agencies where relevant, were involved in the assessment of people’s needs.

People and their relatives told us they had no concerns regarding staff or experiencing harm. One person told us, “I feel safe with my carers. I have not ever had to raise any concerns about my safety with them.”

Staff we spoke with confirmed they knew how to respond to and report any allegations of abuse. However, they did not always receive feedback or an outcome of concerns they reported. One member of staff told us, “It would be helpful to be told what the outcome was when we’ve raised concerns. It would help to know we’ve done the right thing.”

Staff confirmed they had received training and knew where they could access information about safeguarding.

The provider had a system in place for the recording and reporting of any safeguarding concerns, however this was not consistently followed in all areas of the service and effective oversight was not evident.

Whilst we found that referrals had been made to the local authority for some concerns, we were not assured records provided clear details or actions taken with regards to all potential safeguarding concerns. Notifications to CQC had not been submitted for all events as required.

The provider had an up-to date policy in place; however, our findings indicated this was not always followed.

People’s care plans and risk assessments had not always been reviewed in line with the schedules in place.

We found that some risk assessments signposted the reader to care and support plans for further direction and information, however this was then found to be missing.

We found that information within care plans and risk assessments were the same from person to person and we were therefore not assured that assessments were specific to the individual. We also found that key information was missing or inconsistent such as with regards to the management of specific health conditions or the risks associated with each person’s home.

Despite our findings, overall, people told us they felt safe receiving care and felt risks to their health, safety and wellbeing were managed well. One person told us, “I have no concerns regarding my safety and risks.” Another person told us, “I haven’t had any risks explained to me about my care, but I am sure they would if there were any concerns.”

Staff told us they made aware of risks to people via accessing their care plans and associated risk assessments. Care staff told us they were not involved in the assessment of risks but would inform managers or senior staff, if they had concerns.

Where staff provided care to people on a regular basis, they were able to explain people’s individual risks and how they needed to be supported.

The provider used a computerised care planning system in most areas of the service which included the assessment of risks to people. Where the computerised system was not used, risks were manually identified and assessed.

As described previously, we found that while assessments were carried out these were not always reflective of people’s current needs or include all relevant information. These discrepancies had not been identified.

The provider confirmed they would share our feedback with the respective managers of each area of the service for their attention.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People in receipt of a service in their own home or within an extra care setting did not consistently receive a timely service or visits for the duration scheduled for them. We found examples of staff arriving both early and late to visits and cutting visits short. This varied from person to person but was a clear theme across the data we analysed.

People’s feedback was consistent with our findings. One person told us, “I do sometimes feel that more staff are needed as they do seem rushed off their feet.” Another person told us, “Recently we had to ring the office and ask if I can have a 9 am call but they have turned up at 7am and also 10:30am.” A relative told us, “Although they arrive on time, they do not stay the full duration. I don’t know what they are doing.”

People and their relatives offered mixed feedback with regards to the training or skills of staff. One person told us, “They (staff) certainly know what they are doing, and I have nothing to complain about at all.” Another person told us, “99% of the carers are competent in [specific task] but I have had to send away 2 carers who I did not feel were competent.” A relative told us, “They don’t all seem to have the experience to complete the tasks.”

Many staff told us they did not feel they received a sufficient induction or training to support them in their roles. One member of staff told us, “Some new staff are not engaging with people in calls. The induction is just not enough, I don’t trust they are all trained and ready.” Another member of staff told, “A call was missed the other day. It had been assigned to a new member of staff. They had only had 1 day of shadowing.”

Staff told us that rota planning and staff deployment needed improvement. Some staff felt under pressure, whilst others identified conflicts within their rotas and insufficient times between visits. They told us these issues had not been responded to positively when raised with senior staff. One member of staff told us, “I cannot understand the timings of calls and how they are mapped out. We have scheduling clashes, and not enough space between breakfast and lunch calls. I have queried the timings, due to spacing out medicines but nothing in reply.”

The provider used computerised call scheduling software to deploy staff. The provider told us they had designated staff who monitored the electronic call monitoring system. We requested analysis completed of recent call data at the beginning of our assessment but instead was provided with records of completed call data.

The provider told us that staff were expected to complete a ‘visit variation’ record for occasions where a visit completed was outside of the expected duration. We applied the same criteria used to complete our analysis.

We reviewed one calendar month of completed call data and, as described previously, found multiple occasions where staff were either early or late arriving for care visits, and were leaving prior to completing the scheduled duration. For one person we found that timeliness of calls varied from being over an hour early to 40 minutes late and, of these visits, 27 out of 60 were cut short. For another person we found multiple occasions where staff arrived late, these delays varied from 39 minutes to over 2 hours. For another person, who’s care visits required alignment with their medication, we found that none of the 13 visits completed were timely. We found staff arrivals varied from being early by up to an hour to half an hour late.

We raised our findings with provider who confirmed that they had completed a review of the planned routes of care workers and made changes. A tracker had been introduced to record where reassessments were needed to either increase or decrease the duration of calls.

Training records reviewed did not demonstrate that staff had received training in all areas relevant to their role. Within the supported living area of service, evidence provided showed a number of staff who had not completed any training in supporting people with a learning disability or the management of relevant medical conditions. We also identified a person with a specific method of communication and no training had been provided for the members of staff who supported them.

Evidence provided in relation to induction of new staff, or when a member of staff commenced a new role, was incomplete. Records reviewed contained gaps and had not been ‘signed off’ or deemed as completed by a manager.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us that medicines were managed safely. One person told us, “They give my meds to me correctly and it is written up on their phones I believe.” A relative told us, “They do [their] meds for [them] and it is all recorded on the app they have.”

We saw that people’s preferences as to how they wished to be supported with the administration of their medicines was included in care plans, where this was an identified need.

Reviews of people’s medicines were completed; however, we found anomalies within the records and could not be assured of their robustness. The provider confirmed that these audits have been completed by senior care team leaders and the inconsistencies raised would be addressed by a member of the quality team.

Staff told us they understood the safe management of medicines. They confirmed they had received training. One member of staff told us, “My training is all up-to-date and a senior watched my call. I feel safe and competent to do people’s meds.”

A ‘Medication Management Record Keeping Audit’ had been completed for each area of the service. These resulted in a score of compliance. We found that scores for varied between 65.4% and 97.8%. Despite the lower scoring for some areas of the service, none of the audits led to the creation or completion of an action plan to address the areas where improvements had been identified as required.